Sidesteps risky surgery by putting drops in baby's eye

Dr. Violeta Radenovich, a pediatric ophthalmologist at El Paso ChildrenÕs Hospital consults with Tomica Dixon about her 4-month-old daughter Jazmine Dixon before undergoing a Avastin procedure - where doctors give a single injection of the cancer drug Avastin (Intravitreal Bevacizumab) into the eyes of premature babies. It was the first such procudure at the children's hospital.

Mothers who have had their babies prematurely are often frightened and nervous.

And they have every reason to be.

The complications associated with premature newborns -- sometimes referred to as "preemies" -- are numerous and include respiratory problems, cardiac disorders and susceptibility to infections.

Jazmine Dixon was born three months premature and weighed 1 pound, 12 ounces.

"My initial reaction was a lot of fear and guilt," Jazmine's mother, Tomica Dixon, said about giving birth to a premature baby. "You go through all kinds of emotions when your baby is born that early."

Jazmine -- who just turned 4 months old on Thursday and weighs 8 pounds -- was born with retinopathy of prematurity, or ROP, an abnormal blood vessel development in the retina of the eye that affects most premature newborns between 24 and 26 weeks gestation.

"When she was born, the doctor told us there was a possibility that she could develop ROP, especially because she was extremely premature," Dixon said. "I didn't expect her to, but she did. They explained everything to me, and I also did my own research so I could understood what it was and how it worked."

A few weeks ago, Jazmine was the first neonatal ICU patients at El Paso Children's Hospital to go through a Avastin procedure -- in which doctors give a single injection of the cancer drug Avastin (Intravitreal Bevacizumab) into the eyes of premature babies.

Advertisement

"I didn't understand how big of a deal this was until I got there that morning and they told me she was the only one to have this procedure done at the hospital," Dixon said. "At that point, I had to be optimistic about it, because she had nothing to lose. We were very hopeful it would work out."

"In our NICU the treatment of choice is Intravitreal Bevacizumab (Avastin)," said Radenovich, a pediatric ophthalmologist. "I used laser in the past, not anymore. Laser has many disadvantages. It requires general anesthesia, a long procedure 30 to 45 minutes per eye, which is too stressful and traumatic for the baby."

She said some the advantages of Avastin are that it is easy to administer, requires only topical anesthetic drops, does not call for general anesthesia and costs only $50 an injection.

"It could get expensive because it requires highly specialized pediatric ophthalmologist or retina training," she said. "I believe Avastin will be the treatment of choice worldwide in the near future and because of the cost-effectiveness will be able to treat and prevent blindness in premature babies around the world."

Radenovich will speak about her work with Avastin and ROP at the International Course of Neonatologies in Peru this month and will attend the World Congress of ROP next week.

El Paso Children's Hospital is one of 14 hospitals participating in the study, which is being directed by Dr. Helen Mintz-Hittner at the University of Texas Medical School in Houston.

Researchers found that a single injection of Avastin into the eyes of premature babies prevented blindness more effectively than laser surgery. These results were published in the Feb. 17 issue of The New England Journal of Medicine.

"No ocular complications or systemic side effects were present in the infants on the study," Radenovich said. "Some of the babies are 2 years old now, and they see well and are doing great."

Recurrence of ROP occurred in four infants in the Avastin group and 19 infants in the laser-therapy group.

"With this drug therapy, we use a few drops of anesthetic to numb the eye," Mintz-Hittner said in an interview with emaxhealth.com. "We take a syringe with a tiny needle and administer a small amount of the drug directly into the eye. The whole process takes two to three minutes, and you begin to see results within 24 hours."

She said the abnormal vessels virtually disappear and then normal vessels begin to grow out again.

However, compared with laser therapy, the drug therapy does require a longer follow-up.

"You must follow the child for at least 16 weeks following the injection to make sure there isn't a recurrence," Mintz-Hittner said. "Approximately 4 percent of patients (one in every 25 patients) may require a second injection. I explain to parents that it's like a cancer. It can come back and if it isn't treated in time, it can lead to blindness -- so follow-up is very important."

Victor R. Martinez may be reached at vmartinez@elpasotimes.com; 546-6128. Follow him on Twitter @vrmart.

A look into her eyes

Tomica Dixon allowed cameras to film her 4-month-old daughter Jazmine Dixon's Avastin procedure. Jazmine was born with retinopathy of prematurity (or ROP), an abnormal blood vessel development in the retina of the eye.

Dr. Violeta Radenovich, a pediatric ophthalmologist, performed the procedure.